Teenagers and Contraception

birth control

birth control, practice of contraception for the purpose of limiting reproduction.

Methods of Birth Control

Male birth control methods include withdrawal of the male before ejaculation (the oldest contraceptive technique) and use of the condom, a rubber sheath covering the penis. The condom, because of its use as a protection against sexually transmitted diseases, including AIDS, has become a frequently used birth control device.

Contraceptive methods for women include the rhythm method—abstinence around the most likely time of ovulation—and precoital insertion into the vagina of substances (creams, foams, jellies, or suppositories) containing spermicidal chemicals. The use of a diaphragm, a rubber cup-shaped device inserted before intercourse, prevents sperm from reaching the uterine cervix; it is usually used with a spermicide. Contraceptive sponges, which are impregnated with a spermicide, also are inserted into the vagina before intercourse and work primarily by acting as a barrier to the sperm. Intrauterine devices, or IUDs, are variously shaped small objects inserted by a doctor into the uterus; they apparently act by creating a uterine environment hostile either to sperm or to the fertilized egg.

The birth control pill, an oral contraceptive, involves a hormonal method in which estrogen and progestins (progesteronelike substances) are taken cyclically for 21 or 84 days, followed by 7 days of inactive or no pills. The elevated levels of hormones in the blood suppress production of the pituitary hormones (luteinizing hormone and follicle-stimulating hormone) that would ordinarily cause ovulation. An oral contraceptive formulation that utilizes no inactive pills and is taken every day (and completely suppresses menstruation) also exists. Estrogen and progestins may also be delivered through the weekly use of a contraceptive skin patch or the monthly use of a vaginal ring (a flexible plastic ring inserted in the vagina); both slowly release the hormones they contain. Although used primarily for birth control, some oral contraceptives are also prescribed to regulate the menstrual cycle, to relieve symptoms of endometriosis, to treat acne, and for other reasons.

Sterilization of the female, often but not always performed during a Cesarean section or shortly after childbirth, consists of cutting or tying both Fallopian tubes, the vessels that carry the egg cells from the ovaries to the uterus. In male sterilization (vasectomy) the vas deferens, the tubes that carry sperm from the testes to the penis, are interrupted. Sterilization, in most cases irreversible, involves no loss of libido or capacity for sex.

No contraceptive yet devised is at once simple, acceptable, safe, effective, and reversible. Some, such as the diaphragm, condom, and chemical and rhythm methods, require high motivation by users. The pill, which must be taken daily, sometimes induces undesirable side effects, such as nausea, headache, weight gain, and increased tendency to develop blood clots. Use of the pill is also associated with a higher risk of breast and cervical cancer—but a lower risk of cancer of the ovaries and endometrium, benign breast cysts, premenstrual syndrome, and iron-deficiency anemia. The IUDs, although requiring no personal effort or motivation, are often not tolerated or are expelled, and they sometimes, particularly if poorly designed, cause uterine infection, septic abortion, and other problems.

If birth control fails (or is not used), doctors may prescribe several large doses of certain oral contraceptives as
"morning after"
pills or emergency contraceptives; the high level of hormones can inhibit the establishment of pregnancy even if fertilization has taken place. Levonorgestrel, a progestin marketed under the tradename Plan B, is used an emergency contraceptive, and may be effective up to 3 days after sexual intercourse. Approved for use in the United States in 1999, it was made available over-the-counter for women 18 years or older in 2006. Ulipristal acetate, a progesterone agonist/antagonist sold under the tradename ella, was approved as an emergency contraceptive in 2010; it may be effective for up to 5 days after intercourse. Mifepristone, or RU-486, the so-called abortion pill, is effective within seven weeks after conception and requires close medical supervision. It was first approved in Europe and was tested in the mid-1990s in United States, where it was approved in 2000. Another experimental technique is immunization against human chorionic gonadotropin (HCG), a hormone secreted by a developing fertilized egg that stimulates production of progesterone by the ovary; the effect of the anti-HCG antibody would be to inactivate HCG and thereby induce menstruation even if fertilization occurred.

Although contraceptive techniques had been known in ancient Egypt, Greece, and Rome, the modern movement for birth control began in Great Britain, where the writings of Thomas Robert Malthus stirred interest in the problem of overpopulation. By the 1870s a wide variety of birth control devices were available in English and American pharmacies, including rubber condoms and diaphragms, chemical suppositories, vaginal sponges, and medicated tampons. Easy public access to contraceptive devices in the United States aroused the ire of Anthony Comstock and others, who lobbied Congress until it passed (1873) a bill prohibiting the distribution of these devices across state lines or through the mail. Moreover, in England in 1877, Annie Besant and Charles Bradlaugh were tried for selling The Fruits of Philosophy, a pamphlet on contraceptive methods, written in 1832 by an American, Charles Knowlton. After their famous trial, the Malthusian League was founded. Meanwhile, a variety of contraceptive devices remained available to a large public, usually advertised in veiled but unmistakable language.

In 1878 the first birth control clinic was founded in Amsterdam by Aletta Jacobs. The first U.S. birth control clinic, opened (1916) by Margaret Sanger in Brooklyn, N.Y., was closed by the police; she received a 30-day jail sentence. She later permanently established a clinic in New York City in 1923. In Great Britain the Malthusian League, aided by Marie Stopes, established a birth control clinic in London in 1921.

Sanger also helped organize (1917) the National Birth Control League in the United States; in 1921 it became the American Birth Control League, and in 1942 the Planned Parenthood Federation of America. Meanwhile, in 1918 an American judge ruled that contraceptive devices were legal as instruments for the prevention of disease, and the federal law prohibiting dissemination of contraceptive information through the mails was modified in 1936. Throughout the 1940s and 50s, birth control advocates were engaged in numerous legal suits. In 1965 the U.S. Supreme Court struck down the one remaining state law (in Connecticut) prohibiting the use of contraceptives.

The federal government began to take a more active part in the birth control movement in 1967, when 6% of the funds allotted to the Child Health Act was set aside for family planning; in 1970, the Family Planning Services and Population Act established separate funds for birth control. Birth control and sex education in schools continue to be emotional issues in the United States, where adolescent sexual activity and pregnancy rates are high and bring with them increased risks of sexually transmitted diseases and complications of pregnancy, as well as societal and personal costs.

Birth control on the international level is led by the International Planned Parenthood Federation, founded in 1952, with members in 134 countries by 1995. Sweden was one of the first countries to provide government assistance for birth control, which it did as early as the 1930s. Two of the more successful birth control programs have been in Japan, where the birthrate has been dramatically reduced, and—more controversially—in China, where the government has a
"one family, one child"
policy and local authorities have typically intimated women pregnant into aborting a second pregnancy. Several of the so-called underpopulated nations, however, have a stated policy of encouraging an increased birthrate, e.g., Argentina, and concern over declining populations has increased in recent years in certain Western European countries and Russia. Among religious bodies, the Roman Catholic Church has provided the main opposition to the birth control movement; popes Paul VI and John Paul II reaffirmed this stance in encyclicals.

Bibliography

See G. J. Hardin, Birth Control (1970); L. Lader Breeding Ourselves to Death (1971) and The Margaret Sanger Story (1955, repr. 1975); C. Djerassi, The Politics of Contraception (1981); E. Jones, Pregnancy, Contraception, and Family Planning Services in Industrialized Countries (1989); L. V. Marks, Sexual Chemistry: A History of the Contraceptive Pill (2001); A. Tone, Devices and Desires: A History of Contraceptives in America (2001).